Annals of IM: Both Resistance Training and Neuromuscular Exercise Improved Function and Pain in Hip Osteoarthritis Interview with:
Troels Kjeldsen
PhD Student, MSc
Department of Orthopedic Surgery, Aarhus University Hospital
Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Indgang J, J501 
Department of Clinical Medicine, Aarhus University
The Research Unit PROgrez,
Department of Physiotherapy and Occupational Therapy
Næstved-Slagelse-Ringsted Hospitals

Troels-Kjeldsen What is the background for this study?

Response: Hip osteoarthritis (OA) is a very common degenerative joint disease that results in hip pain and impaired physical function among other consequences for the individual.

Systematic reviews of randomized controlled trials of exercise and hip OA have established that exercise is an effective conservative treatment option for reducing pain and improving physical function. In most clinical guidelines, exercise is the recommended first line treatment in combination with patient education and a weight loss intervention if necessary.

However, we know very little about which types of exercise are most effective and there is currently not an evidence basis on which doctors and physiotherapists can make recommendations of one type of exercise over another type.

Racial Differences in Chronic Pain Among Football Players Interview with:
Robert R Edwards, Ph.D.
Associate Professor of Anaesthesia
Pain Management Center
Brigham and Women’s Hospital What is the background for this study?

Response: Chronic pain affects over 100 million American adults, and is a leading cause of reduced quality of life. However, in the US, the of burden of pain falls most heavily on members of racial and ethnic minority groups who frequently report more pervasive and severe pain compared with those in the majority.

In this study we evaluated race differences in pain among nearly 4,000 former professional American-style football players who self-identified as either Black or white.

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Both High and Low Dose Exercise Beneficial for Knee Osteoarthritis Interview with:
Tom Arild Torstensen
Department of Neurobiology, Care Sciences and Society
Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and
Holten Institute, Stockholm, Sweden 

Tom Arild Torstensen What are the main findings?
Response: The results from our study (1) show that both high-dose and low-dose exercise therapy is beneficial for knee osteoarthritis. At a glance, it would be natural to think that I should choose a low-dose because it takes only 30 minutes and consists of 5 different exercises compared to the high-dose lasting 70 to 90 minutes consisting of 11 exercises. But because our study was designed as a superiority trial, meaning that even though we failed to show that high-dose treatment is superior to low-dose, our results do not imply that a low-dose exercise regimen is as beneficial as a high-dose regimen. 

Both groups improved over time, but there were no benefits of high-dose therapy in most comparisons. One exception was the KOOS score function in sports and recreation, where high-dose therapy was superior at the end of treatment and the 6-month follow-up. A small benefit in QoL at 6 months was also observed. Notably, most variables numerically favored the high-dose group, albeit not in a statistically or clinically meaningful way.

Study Finds Physical Exercise Increases Body’s Own Cannabis-Type Substances Interview with:
Amrita Vijay PhD
Division of Rheumatology
Orthopedics and Dermatology
School of Medicine
University of Nottingham
Nottingham, UK

Dr. Vijay  What is the background for this study? What are the main findings?

Response: We carried out this research as we wanted to see if exercise had an effect on the levels of anti-inflammatory substances produced by gut microbes and on endocannabinoids (i.e cannabis-like substances) produced by our bodies.  

One of the key findings of the study is that physical exercise increases levels of the body’s own cannabis-type substances and highlights a key link between how substances produced by our gut microbes interact with these cannabis-like substances and reduces inflammation.  

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Runners: Leaning Forward Increases Force on Hip Extensors Interview with:
Anna Warrener Ph.D.
Department of Anthropology
University of Colorado Denver
Denver, CO

Dr. Warrener  What is the background for this study?

Response: We became interested in looking at trunk position during running because one of us (Daniel Lieberman) had anecdotally observed people running with a variety of trunk positions, and when we went looking for academic literature on the topic, we found it was fairly scarce. We suspected that trunk position could have a major impact on the forces experienced by the lower limbs during running and even affect aspects of gait (stride length and time). So we developed a model predicting how these forces and movements might change as trunk flexion/forward leaning increased.

Our primary predictions were that more forward lean would increase “overstride” which is the distance in side view between the hip and the heel as it contacts the ground (a measure of how far your are extending your leg when you step). This in turn would increase the impact forces experienced by the lower limb at initial contact which have previously been shown to increase the risk of repetitive stress injuries. We also predicted that stride would get longer and take more time because extending the leading leg out farther forward (overstriding) would be necessary to keep the body center of mass within a base of support above the limbs. This more extended limb, we predicted, would change the angles and forces about the ankle, knee and hip joints.

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Targeted Smartphone Exercise Program Can Provide Pain Relief from Knee Arthritis Interview with:
Ana M Valdes MA PhD
Professor in Molecular and Genetic Epidemiology
NIHR Nottingham Biomedical Research Centre – Research Area Lead
Associate Editor European Journal of Clinical Nutrition
School of Medicine
University of Nottingham

Dr. Valdes  What is the background for this study?

Response: Knee osteoarthritis and knee pain affect a large proportion of middle age and aging individuals and this are  an increasing problem. Physical exercises aimed at strengthening and stabilising the muscles in the legs and hips  are known to be highly effective in reducing pain and improving the ability to walk and get on with life. But a key challenge is how to deliver such gradual exercises in a way that does not require people to travel to see a physiotherapist or a doctor, particularly given the issues raised by  lockdown both in terms of the Covid-secure challenges face to face visits and also given the strain that the pandemic has put on health services.  

Our  study was the first randomised controlled trial in the UK where we were had people with painful knee osteoarthritis either do only what their doctors normally recommend or, in addition, follow a programme of exercised developed in Sweden delivered via  smartphone app. The research participants were assessed for knee inflammation, knee pain, pain sensitivity around the knee, muscle strength, and ability to walk and get up from a chair both before and after the 6 week smartphone delivered intervention (or a 6 week period simply following any advice they had from their family doctor).

Motion Control Shoes May Reduce Painful Injuries in Some Pronation-Prone Runners Interview with:
Laurent Malisoux, PhD
Group Leader, Public Health Research
Department of Population Health
Luxembourg Institute of Health  What is the background for this study?

Response: Pronation refers to the way the foot rolls inward during the gait cycle. Foot pronation during running is normal, but over-pronation (increased amount or poor timing) has previously been related to the risk of running-related injury. Indeed, alterations in the movements at the foot-ankle complex results in abnormal repetitive load, and may subsequently lead to an injury at the foot-ankle complex or more proximally in the kinetic chain. A previous trial demonstrated that motion control shoes reduced the risk of injury in recreational runners.1

Importantly, in the previous trial, the effect of motion control shoe was investigated on all injury types concurrently. However, risk factors as well as mechanisms underlying the development of injury might differ across injury types. Thus, motion control shoes may only be effective in preventing some injury types, and the effect might be partially masked if it is assessed on different injury types concurrently.

The present study is a secondary analysis of the abovementioned trial. Based on previous literature, we assumed that some injury types, namely Achilles tendinopathy, plantar fasciopathy, exercise-related lower leg pain and anterior knee pain, were related to over-pronation and were defined as pronation-related running injuries, while other running-related injuries are not. We hypothesised that motion control shoes aiming at reducing excessive pronation would reduce the risk of pronation-related running injuries in recreational runners compared to shoes with no motion control technology.

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Study Finds Millions of Adults Could Reduce Pain and Improve Physical Function with Exercise Interview with:
George A. Kelley, DA, FACSM
Professor & Director, Meta-Analytic Research Group
2019 WVU SPH Excellence in Graduate Teaching Recipient
School of Public Health
Department of Biostatistics
West Virginia University
Morgantown, WV 

George A. Kelley, DA, FACSM
Professor & Director, Meta-Analytic Research Group
2019 WVU SPH Excellence in Graduate Teaching Recipient
School of Public Health
Department of Biostatistics
West Virginia University
Morgantown, WV
Dr. Kelley  What is the background for this study?  What are the main findings?

Response: Given that arthritis effects 54.4 million US adults and more than 23 million have arthritis-attributable activity limitations and another 14.6 million report severe joint pain, we estimated the number of physically inactive US adults with arthritis who could improve their physical function and pain by exercising. Using data from our previously published meta-analytic study as well as published data from the Centers for Disease Control (CDC) and US Census Bureau, we found that overall, more than 4 million adults could improve their physical function and more than 2 million could improve their pain control by starting and maintaining a regular program of exercise, for example, walking briskly for 150 minutes per week, i.e., 5 days per week, 30 minutes per session. Current recommendations regarding physical activity and exercise in adults with arthritis can be found on the CDC Arthritis Program homepage:    

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